Asia Pacific Journal of Clinical Nutrition

Volume 14, issue 2 (June 2005)

Full Papers

Contents	Abstract	Paper
Review Articles
Lean meat and heart health DUO LI, SIRITHON SIRIAMORNPUN, MARK L WAHLQVIST, NEIL J MANN AND ANDREW J SINCLAIR Asia Pac J Clin Nutr. 2005;14(2):113-119.	html	pdf
Enhancing health benefits of berries through phenolic antioxidant enrichment: focus on cranberry DHIRAJ A VATTEM, REZA GHAEDIAN AND KALIDAS SHETTY Asia Pac J Clin Nutr. 2005;14(2):120-130.	html	pdf
Original Articles
Increases in plasma lycopene concentration after consumption of tomatoes cooked with olive oil JEANETTE M FIELDING, KEVIN G ROWLEY, PAULINE COOPER AND KERIN O'DEA Asia Pac J Clin Nutr. 2005;14(2):131-136.	html	pdf
Dietary vitamin A may be a cardiovascular risk factor in a Saudi population EMAN M ALISSA, SUHAD M BAHJRI , NABEEL AL-AMA, WAQAR H AHMED, BRYAN STARKEY AND GORDON AA FERNS Asia Pac J Clin Nutr. 2005;14(2):137-144.	html	pdf
Anti-diabetic and anti-hypertensive potential of sprouted and solid-state bioprocessed soybean PATRICK McCUE, YOUNG-IN KWON AND KALIDAS SHETTY Asia Pac J Clin Nutr. 2005;14(2):145-152.	html	pdf
Antioxidant properties of Momordica Charantia (bitter gourd) seeds on Streptozotocin induced diabetic rats DHANASEKAR SATHISHSEKAR AND SORIMUTHU SUBRAMANIAN Asia Pac J Clin Nutr. 2005;14(2):153-158.	html	pdf
Sources of household salt in South Africa PIETER L JOOSTE Asia Pac J Clin Nutr. 2005;14(2):159-162.	html	pdf
Diet quality status of most Tehranian adults needs improvement LEILA AZADBAKHT, PARVIN MIRMIRAN, FIROOZEH HOSSEINI AND FEREIDOUN AZIZI Asia Pac J Clin Nutr. 2005;14(2):163-168.	html	pdf
High prevalence of overweight and obesity in women of Islamshahr, Iran GITY SOTOUDEH, SHAHLA KHOSRAVI, FARAHNAZ KHAJEHNASIRI AND HAMID REZA KHALKHALI Asia Pac J Clin Nutr. 2005;14(2):169-172.	html	pdf
Folic acid fortified milk increases blood folate and lowers homocysteine concentration in women of childbearing age TIMOTHY J GREEN, C MURRAY SKEAFF, JENNIFER EP ROCKELL AND BERNARD J VENN Asia Pac J Clin Nutr. 2005;14(2):173-178.	html	pdf
Maternal total homocysteine concentration and neonatal size in India CHITTARANJAN S YAJNIK, SWAPNA S DESHPANDE, ANJALI V PANCHANADIKAR, SADANAND S NAIK, JYOTI A DESHPANDE, KURUS J COYAJI, CAROLINE FALL AND HELGA REFSUM Asia Pac J Clin Nutr. 2005;14(2):179-181.	html	pdf
Management of chylothorax and chylopericardium in pediatric patients: experiences at Siriraj Hospital, Bangkok NARUMON S DENSUPSOONTORN, PIPOP JIRAPINYO, RENU WONGARN, NUCHNOI THAMONSIRI, APICHART NANA, DUANGMANEE LAOHAPRASITIPORN, JARUPIM SOONGSWANG, KRITVIKROM DURONGPISITKUL, AND SAMPHANT PORNVILAWAN Asia Pac J Clin Nutr. 2005;14(2):182-187.	html	pdf
Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia HESHAM MS AL-MEKHLAFI , M AZLIN, U NOR AINI, A SHAIK, A SA'IAH, MS FATMAH, MG ISMAIL, FIRDAUS AHMAD, MY AISAH, AR ROZLIDA AND M NORHAYATIY Asia Pac J Clin Nutr. 2005;14(2):188-194.	html	pdf
Recurrent D-lactic acidosis in a child with short bowel syndrome MANEERAT PUWANANT, LADDA MO-SUWAN AND SAKDA PATRAPINYOKUL Asia Pac J Clin Nutr. 2005;14(2):195-198.	html	pdf

top
Lean meat and heart health
DUO LI, SIRITHON SIRIAMORNPUN, MARK L WAHLQVIST, NEIL J MANN AND ANDREW J SINCLAIR
The general health message to the public about meat consumption is both confusing and misleading. It is stated that meat is not good for health because meat is rich in fat and cholesterol and high intakes are associated with increased blood cholesterol levels and coronary heart disease (CHD). This paper reviewed 54 studies from the literature in relation to red meat consumption and CHD risk factors. Substantial evidence from recent studies shows that lean red meat trimmed of visible fat does not raise total blood cholesterol and LDL-cholesterol levels. Dietary intake of total and saturated fat mainly comes from fast foods, snack foods, oils, spreads, other processed foods and the visible fat of meat, rather than lean meat. In fact, lean red meat is low in saturated fat, and if consumed in a diet low in SFA is associated with reductions in LDL-cholesterol in both healthy and hypercholesterolemia subjects. Lean red meat consumption has no effect on in vivo and ex vivo production of thromboxane and prostacyclin or the activity of haemostatic factors. Lean red meat is also a good source of protein, omega-3 fatty acids, vitamin B12, niacin, zinc and iron. In conclusion, lean red meat, trimmed of visible fat, which is consumed in a diet low in saturated fat does not increase cardiovascular risk factors (plasma cholesterol levels or thrombotic risk factors).
Key Words: nuts, meat, heart disease, CHD risk factors, LDL cholesterol, saturated fat, polyunsaturated fatty acids.
top

Enhancing health benefits of berries through phenolic antioxidant enrichment: focus on cranberry
DHIRAJ A VATTEM, REZA GHAEDIAN AND KALIDAS SHETTY
Emerging epidemiological evidence is increasingly pointing to the beneficial effects of fruits and vegetables in managing chronic and infectious diseases. These beneficial effects are now suggested to be due to the constituent phenolic phytochemicals having antioxidant activity. Cranberry like other fruits is also rich in phenolic phytochemicals such as phenolic acids, flavonoids and ellagic acid. Consumption of cranberry has been historically been linked to lower incidences of urinary tract infections and has now been shown to have a capacity to inhibit peptic ulcer-associated bacterium, Helicobacter pylori. Isolated compounds from cranberry have also been shown to reduce the risk of cardiovascular diseases. Recent evidence suggests the ability of phytochemical components in whole foods in being more effective in protectively supporting human health than compared to isolated individual phenolic phytochemicals. This implies that the profile of phenolic phytochemicals determines the functionality of the whole food as a result of synergistic interaction of constituent phenolic phytochemicals. Solid state bioprocessing using food grade fungi common in Asian food cultures as well as cranberry phenolic synergies through the addition of functional biphenyls such as ellagic acid and rosmarinic acid along with processed fruit extracts have helped to advance these concepts. These strategies could be further explored to enrich cranberry and cranberry products with functional phytochemicals and further improve their functionality for enhancing health benefits.
Key Words: antioxidant activity, antimicrobial activity, free radical scavenging, cranberry, fruit phytochemicals, phenolic antioxidant, synergy, solid-state bioprocessing

top .

Increases in plasma lycopene concentration after consumption of tomatoes cooked with olive oil
JEANETTE M FIELDING, KEVIN G ROWLEY, PAULINE COOPER AND KERIN O'DEA
Lycopene is the main carotenoid in tomatoes and it has been hypothesised to be responsible for reducing the risk of some cancers and heart disease. The cooking of tomatoes with olive oil is a characteristic combination in the Southern Mediterranean diet. Previous studies have shown that the absorption of lycopene is greater from processed tomatoes than fresh tomatoes, since the processing breaks down the tomato cell matrix and makes the lycopene more available. The aim of the present study was to determine whether consumption of diced tomatoes cooked with olive oil resulted in higher plasma lycopene concentrations than consumption of diced tomatoes cooked without olive oil. Plasma lycopene concentrations were measured after 5 days on a low lycopene diet and again after a five-day dietary intervention, in healthy subjects, who consumed one meal per day of tomatoes (470 g) cooked with or without extra virgin olive oil (25 ml olive oil). There was an 82% increase in plasma trans-lycopene (P < 0.001) and a 40% in cis-lycopene (P = 0.002) concentrations in the 11 subjects who consumed tomatoes cooked in olive oil. There was no significant change in trans-lycopene (P=0.684) and a 15% increase in cis-lycopene (P = 0.007) concentrations in 12 subjects consuming tomatoes cooked without olive oil. We conclude that the addition of olive oil to diced tomatoes during cooking greatly increases the absorption of lycopene. The results highlight the importance of cuisine (i.e how a food is prepared and consumed) in determining the bioavailability of dietary carotenoids such as lycopene.
Key Words: antioxidant, lycopene, tomatoes, olive oil, cuisine, bioavailability, Mediterranean cuisine.
top

Dietary vitamin A may be a cardiovascular risk factor in a Saudi population
EMAN M ALISSA, SUHAD M BAHJRI , NABEEL AL-AMA, WAQAR H AHMED, BRYAN STARKEY AND GORDON AA FERNS
Traditional risk factors do not appear to explain fully the variation in the incidence of the cardiovascular diseases (CVD). Epidemiological studies have not been entirely consistent with regard to the relationship between antioxidant vitamin intake and CVD and there appears to be little data on this relationship in non-Caucasian populations. This study aimed to investigate the dietary intake of vitamin A, C, and vitamin E, and carotenoids, serum concentrations of vitamin E and A and indices of lipid peroxidation were measured in male Saudi patients with established CVD and age-matched controls. We assessed the dietary intakes of vitamins A, C, and E and carotenoids, by a food frequency questionnaire. Serum vitamins A and E concentrations were measured by HPLC, in 130 Saudi male subjects with established CVD, and 130 age-matched controls. We also determined serum lipid profiles (total cholesterol, triglycerides, HDL-C, LDL-C), lipoprotein (a), oxidized LDL, and serum lipid peroxide concentrations. Diabetes mellitus (P<0.0001), a positive smoking habit (P<0.0001) and hypertension (P<0.05) were more prevalent among CVD patients. Levels of dietary vitamin E and A were also significantly higher among cases. In conditional logistic regression analysis, the most significant characteristics differentiating CVD patients from controls were diabetes mellitus (Odds ratio 2.49, CI 1.42-4.37, P<0.001), total fat intake (Odds ratio 1.02, CI 1.01-1.03, P<0.01), serum vitamin A (Odds ratio 0.72, CI 0.53-0.99, P<0.05), and the vitamin A/total fat intake ratio (Odds ratio 1.04, CI 1.01-1.06, P<0.01). In a Saudi population, smoking habit and hypertension were significantly more common among patients with CVD. Multivariate analysis showed that dietary total fat and vitamin A and the presence of diabetes mellitus were independent coronary risk factors. This is the first report of a potentially deleterious effect of dietary vitamin A in a non-Caucasian population. However it is possible that unidentified residual confounding factors may account for this finding.
Key Words: vitamins A, C, and E, coronary disease, risk factors, lipid peroxides, dietary antioxidant vitamin intake, oxidative stress, coronary atherosclerosis, Saudi Arabia, Jeddah.

top

Anti-diabetic and anti-hypertensive potential of sprouted and solid-state bioprocessed soybean
PATRICK McCUE, YOUNG-IN KWON AND KALIDAS SHETTY
Long-term type 2 diabetes can lead to numerous biological complications, such as hypertension and cardio-vascular disease. Key enzymes involved in the enzymatic breakdown of complex carbohydrates, pancreatic a-amylase and intestinal a-glucosidase, have been targeted as potential avenues for modulation of type 2 diabetes-associated post-prandial hyperglycemia through mild inhibition of their enzymatic activities so as to decrease meal-derived glucose absorption. Further, inhibition of hypertension-linked angiotensin I-converting enzyme (ACE) was targeted as a potential approach for modulation of diabetes-linked hypertension. Water-soluble extracts of soybean optimized for phenolic content via sprouting or bioprocessing by dietary fungus (Rhizopus oligosporus, Lentinus edodes) were investigated for inhibitory activity against porcine pancreatic a-amylase (PPA), yeast a-glucosidase, and rabbit lung ACE in vitro. PPA was allowed to react with each phenolic-optimized extract and the derivatized enzyme-phytochemical mixtures obtained were characterized for residual amylase activity. a-Glucosidase and ACE activities were determined in the presence of each phenolic-optimized extract. All of the soybean extracts possessed marked anti-amylase activity, with extracts of R. oligosporus-bioprocessed soybean having the strongest inhibitory activity, but only slight anti-glucosidase activity. The anti-amylase activity of each extract seemed associated with extract antioxidant activity. Anti-enzyme activity was slightly associated with total soluble phenolic content per se, but seemed more associated to the length of sprouting or bioprocessing of the soybean substrate. Short-term sprouting or bioprocessing seemed to improve anti-amylase activity, while long-term sprouting or bioprocessing seemed to aid anti-glucosidase activity. While ACE activity was strongly inhibited by all of the soybean extracts (44-97%), only sprouting was found to increase this inhibition and bioprocessing of soybean with L. edodes decreased inhibitory activity of soybean extract. The results suggest that sprouting and dietary fungal bioprocessing of soybean improve the anti-diabetic potential of soybean extracts, potentially through modulation of the phenolic profile of the extract, and further suggest that enzyme inhibitory activity may be linked to phenolic antioxidant mobilization during spouting and/ or bioprocessing. The significance of food-grade, plant-based enzyme inhibitors for modulation of carbohydrate breakdown and control of glycemic index of foods in the context of preventing hyperglycemia and diabetes mellitus complications such as hypertension in the long-term is hypothesized and discussed.
Key Words: alpha amylase, alpha glucosidase, angiotensin I-converting enzyme, soybean, Rhizopus, Lentinus, hyperglycemia, hypertension, diabetes, obesity.

top

Antioxidant properties of Momordica Charantia (bitter gourd) seeds on Streptozotocin induced diabetic rats
DHANASEKAR SATHISHSEKAR AND SORIMUTHU SUBRAMANIAN
The aim of the present study is to investigate the antioxidant activities of the aqueous extract of seeds of two varieties, namely a country and hybrid variety of Momordica charantia (MCSEt1 and MCSEt2) respectively in streptozotocin induced diabetic rats. Oral administration of both the seed extracts at a concentration of 150 mg/kg b.w for 30 days showed a significant decrease in fasting blood glucose, hepatic and renal thiobarbituric acid reactive substances and hydroperoxides. The treatment also resulted in a significant increase in reduced glutathione, superoxide dismutase, catalase, glutathione peroxidase and glutathione-s-transferase in the liver and kidney of diabetic rats. The results clearly suggest that seeds of Momordica charantia treated group may effectively normalize the impaired antioxidant status in streptozotocin induced-diabetes than the glibenclamide treated groups. The extract exerted rapid protective effects against lipid peroxidation by scavenging of free radicals there by reducing the risk of diabetic complications. The effect was more pronounced in MCSEt1 compared to MCSEt2.
Key Words: Momordica charantia, bitter gourd seeds, streptozotocin, diabetes, antioxidant enzymes.

top

Sources of household salt in South Africa
PIETER L JOOSTE
Marketing of non-iodized salt through unconventional distribution channels is one of the factors weakening the national salt iodization program in South Africa. The aim of this study was therefore to quantify the various sources of household salt, and to relate this information to socio-economic status. Questionnaire information was collected by personal interview during home visits from a multistage, cluster, probability sample of 2164 adults representative of the adult population. Nationally 77.7% of households obtained their table salt from the typical food shops distributing iodized salt. However, in the nine different provinces between 8 and 37.3% of households used unconventional sources, distributing mainly non-iodized salt, to obtain their household salt. These alternative sources include distributors of agricultural salt, small general dealer shops called spaza shops, in peri-urban and rural townships, street vendors and salt saches placed in the packaging of maize meal bags. Countrywide around 30% of low socio-economic households obtained their salt from unconventional sources compared to less than 5% in high socio-economic households, emphasizing the vulnerability of low socio-economic groups to the use of non-iodized salt. Intervention strategies should mobilize all role players involved in unconventional marketing channels of household salt to provide only iodized salt to consumers, as required by law.
Key Words: iodine, salt, household salt, socio-economic status, South Africa.
top
Diet quality status of most Tehranian adults needs improvement
LEILA AZADBAKHT, PARVIN MIRMIRAN, FIROOZEH HOSSEINI AND FEREIDOUN AZIZI
The healthy eating index (HEI) was developed to track the quality of diets in different societies. The aim of this study was to determine the HEI score of Tehranian adults. This study, conducted within the framework of Tehran Lipid and Glucose Study (TLGS), was a part of a dietary intake assess-ment carried out in 819 cases aged 19 and over. Dietary intake was assessed with two 24-hour recalls. HEI was calculated based on 9 components. The HEI score was categorized into three groups: less than 45 (poor diet), between 45-72 (needs improvement) and more than 72 (good diet). The mean score of HEI was 65.8 ± 9.6 in men and 65.9 ± 8.6 in women. The results showed that the number of servings of food groups in those with good diet was significantly higher than the two other groups (P<0.05). The percentage of observations failing to meet the estimated average requirements (EAR) in the poor diet group (HEI<45) was higher than the other diet groups for most of the nutrients. Diets were categorized into: needs improvement (74%); good (23%); and poor (3%). Since the majority of the sample needed to improve their diet, this suggests that nutrition intervention may be needed.
Key Words: diet quality, food groups, Healthy Eating Index (HEI), Tehranian adults, Iran
top

High prevalence of overweight and obesity in women of Islamshahr, Iran
GITY SOTOUDEH, SHAHLA KHOSRAVI, FARAHNAZ KHAJEHNASIRI AND HAMID REZA KHALKHALI
This study determined the prevalence of overweight, overall and central obesity in female adolescents and women and their possible association with marital status, occupation, literacy, parity, daily meal and snack consumption. The study was a cross-sectional, random survey of households. Rural and urban areas of Islamshahr district in Iran were selected and 1003 female adolescents and women aged 10-65 years were studied. The frequency of overweight and obesity were similar in rural and urban areas. On the basis of body mass index (BMI), more than 19% of adolescents were overweight or at risk of it and 66.8% of adult females were overweight or obese. Frequency of central obesity [waist to hip ratio (WHR) =0.85] was 35.7% in all females. The mean BMI was significantly higher in married women and in women with less than 8 years of formal education. The mean WHR was significantly higher in women with less than 8 years of education or with more than 6 parity female adults. In addition, the mean BMIs and WHRs were significantly higher in women without any daily snack consumption. Overweight and obesity was very common in adult females of Islam shahr thus prevention of overweight and obesity through a healthy diet and increased physical activity should now be an important priority area. .
Key Words: obesity, overweight, women, BMI, WHR, Islamshahr, Iran

top

Folic acid fortified milk increases blood folate and lowers homocysteine concentration in women of childbearing age
TIMOTHY J GREEN, C MURRAY SKEAFF, JENNIFER EP ROCKELL AND BERNARD J VENN
Daily consumption of 400 µg folic acid prior to conception and during early pregnancy is recommended for the prevention of neural tube defects (NTD). Strategies to increase folic acid consumption include supplements and fortified foods. Milk is consumed by women and can be fortified with folic acid but little is known about the effect of fortified milk on blood folate concentration in women of childbearing age. The objective of this study was to determine whether daily consumption of milk fortified with 375µg folic acid increases blood folate and lowers homocysteine concentrations in women of childbearing age. Seventy-three non-pregnant women (aged 18-47 y) were randomized to receive either 75 g/d of a fortified or unfortified (control) milk powder for 12 weeks. Women who consumed the folic acid fortified milk had mean (95% CI) red blood cell and plasma folate concentrations that were 539 nmol/L (436, 641) and 35 nmol/L (30, 41) higher, respectively, than in the control group. Women drinking fortified milk had a 14% lower mean plasma homocysteine concentration at week 12 than women consuming the control milk. Daily consumption of fortified milk powder providing 375µg folic acid increases blood folate and lowers homocysteine concentrations over 12 weeks in women of childbearing age. Daily consumption of fortified milk would be expected to reduce NTD risk..
Key words: folic acid, milk, NTD, fortification, red blood cell folate, plasma folate, homocysteine, women.

top

Maternal total homocysteine concentration and neonatal size in India
CHITTARANJAN S YAJNIK, SWAPNA S DESHPANDE, ANJALI V PANCHANADIKAR, SADANAND S NAIK, JYOTI A DESHPANDE, KURUS J COYAJI, CAROLINE FALL AND HELGA REFSUM
The smallness of Indian babies is ascribed to small maternal size and their chronic under nutrition. Micronutrient nutrition of the mother may be particularly important. We investigated the relationship between maternal circulating concentrations of total homocysteine (tHcy), vitamin B12 and folate and offspring size at birth. Mothers of full term small for gestation age babies (SGA, gestation and sex specific birth weight <10th centile, N = 30) and mothers of appropriate for gestational age babies (AGA, >10th centile, N = 50) were compared for their body size, plasma tHcy, vitamin B12 and red cell folate concentration at 28week gestation. Mothers of SGA babies were lighter and shorter than those of AGA babies (P <0.05, both) and had higher plasma tHcy concentration (P<0.01). Total homocysteine concentrations were inversely related to plasma vitamin B12 and red cell folate concentrations (r = ~ -0.5, P <0.01, both). Seventy percent of the women had a low vitamin B12 status (plasma vitamin B12 <150 pmol/L) but none were folate deficient (red cell folate <283 nmol/L). Higher maternal plasma tHcy concentration was significantly associated with lower offspring birth weight (r=-0.28, P<0.05 adjusting for maternal height, weight, gestation at delivery and the baby's gender), this effect was reduced by adjustment for red cell folate concentration. We conclude that maternal vitamin B12 deficiency reflected in plasma tHcy concentration contributes to small size of Indian babies.
Key Words: total-Homocysteine, vitamin B12, folate, neonatal size, India
top

Management of chylothorax and chylopericardium in pediatric patients: experiences at Siriraj Hospital, Bangkok
NARUMON S DENSUPSOONTORN, PIPOP JIRAPINYO, RENU WONGARN, NUCHNOI THAMONSIRI, APICHART NANA, DUANGMANEE LAOHAPRASITIPORN, JARUPIM SOONGSWANG, KRITVIKROM DURONGPISITKUL, AND SAMPHANT PORNVILAWAN
Chylothorax and chylopericardium are rare conditions occurring in infants and children. Both may be traumatic or nontraumatic in origin. We reviewed our experiences with the management of sixteen pediatric cases (10 males, 6 females; 11days to 14years old) of chylothorax and chylopericardium from 1997 to 2003. There were fifteen cases of chylothorax (9 left, 2 right, 4 bilateral) and two cases of chylopericardium (1 isolated and 1 associated with chylothorax), and their incidences of occurrence after cardiothoracic surgery were 0.89% and 0.12%, respectively. Of the fifteen cases occurring after cardiothoracic surgery, thirteen patients had corrective or palliative surgery for complex congenital heart disease, and two patients had removal of thymolipoma and neuroblastoma, respectively. Included also in this review was an 11-day old preterm infant with hydrops fetalis and congenital heart disease who developed chylothorax. Characteristics of chylous effusion included a presence of whitish opaque fluid in the pleural cavity and the pericardial cavity, having a triglyceride content ranging from 59 to 1689 mg/dl which was higher than a plasma triglyceride, a protein content of 2.4 to 7.4 g/dl, and a presence of lymphocyte predominance. The average latent period for diagnosis of chylothorax or chylopericardium was 13 days (range 3-30). All patients were treated primarily with nutritional modification using medium-chain triglycerides (MCT) instead of long-chain triglycerides in their diet; and only a few cases needed bowel rest with total parenteral nutrition (TPN). Twelve patients completely responded to a MCT-rich diet; two cases resolved after switching to TPN and another case needed surgery for ligation of lymphatic vessels around the thymus gland. The mean duration of lymph drainage was 12.1 days (range 3-29) and the average length of time of continued conservative treatment (MCT-rich diet and TPN) was 29.8 days (range 18-47). Fourteen patients (87.25%) had good outcome, i.e. resolution from chylothorax or chylopericardium and return to normal diet. Two of the fourteen patients developed severe infections; one was diagnosed with suspected bacterial endocarditis and the other had candidemia. However, both responded well to antibacterial and antifungal drugs, respectively. One case succeeded after surgery. A case that had low compliance with dietary recommendations and required repeated placement of drainage devices died due to infection with enterococcal septicemia. Early and good compliance with MCT-rich diet is essential for achieving a favorable outcome in the management of chylothorax and chylopericardium in children.
Key Words: chylothorax, chylopericardium, total parenteral nutrition, MCT-rich diet, pediatric, Bangkok, Thailand
top

Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia
HESHAM MS AL-MEKHLAFI , M AZLIN, U NOR AINI, A SHAIK, A SA'IAH, MS FATMAH, MG ISMAIL, FIRDAUS AHMAD, MY AISAH, AR ROZLIDA AND M NORHAYATIY
This study aims to determine the prevalence of protein-energy malnutrition and its association with soil-transmitted helminthiases in Orang Asli (Aborigine) children in Selangor, Malaysia. The results obtained from 368 children aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1% and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5% respectively. The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%, 98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present study vividly shows that stunting and underweight are highly prevalent among Orang Asli children and therefore of concern in this community. In this population intestinal parasitic infections, especially severe trichuriasis and giardiasis, were identified as the main predictors of stunting and wasting respectively, in addition to age between 2 to 6 years.
Key Words: protein-energy malnutrition in children, underweight, stunting, soil-transmitted helminthiases, intestinal parasitic infections, ascariasis, trichuriasis, hookworm infection, giardiasis, Orang Asli, Aborigine, Selangor, Malaysia
top

Recurrent D-lactic acidosis in a child with short bowel syndrome
MANEERAT PUWANANT, LADDA MO-SUWAN AND SAKDA PATRAPINYOKUL
D-lactic acidosis is a rare complication in children with short bowel syndrome. It results from fermentation of dietary carbohydrate by luminal bacteria in the small bowel caused by bacterial overgrowth. We present the case of a 14-year-old boy who had been diagnosed with short bowel syndrome from surgical treatment of midgut volvulus five years previously. His nutritional status was maintained by total parenteral nutrition and enteral feeding as tolerated. During hospitalization, episodic confusion and hyperpnea developed. The investi-gation showed severe metabolic acidosis with serum bicarbonate of 9 mmol/L and a wide anion gap. The serum D-lactic acid was 11.21 mmol/L. There was no evidence of renal or hepatic failure. Therefore, D-lactic acidosis from enteral carbohydrate overload was diagnosed. The treatment was correction of metabolic acidosis by sodium bicarbonate infusion and carbohydrate restriction. The results of the therapy were satisfactory. Early detection and appropriate treatment is necessary to avoid morbidity and mortality following this complication of short bowel syndrome.
Key Words: lactic acidosis, short bowel syndrome.
top

 

Last Updated: May 2005